fiscal officers training manual - New York State Conference of Local ...

OMH anticipates that visits can be counted toward uncompensated care volume if they meet the following conditions:1. Self pay, including partial pay or no pay visits (does not include partial payment associated with co-pays ordeductibles).2. Required or optional mental health clinic procedures (as defined in OMH regulations) provided but not coveredunder a clinic’s agreement with an insurer. The service must be provided by a practitioner qualified to deliver theservice under state regulations.3. Unreimbursed clinic visits/procedures appropriately provided to an insured recipient by a clinic staff member notapproved for payment by a third party payor in contract with the clinic. The provider must document that the clinicor recipient received a denial of payment.4. Unreimbursed clinic visits/procedures appropriately provided to an insured recipient by a clinic staff member whenthe procedure is not reimbursed by a third party payer not in contract with the clinic. Only visits for which the clinicreceived a denial of payment from the insurer or an attestation from the client/insured that the insurer made nopayment will be considered uncompensated. This documentation must be retained by the clinic and will besubject to an audit by the New York State Office of the Medicaid Inspector General or other party empowered toconduct such audits.Visits will not be counted if they meet the following conditions:1. Visits paid in whole or part by a third party payer (including Medicaid Managed Care).2. Visits not authorized (considered not medically necessary) by an insurer/managed care plan.3. Visits provided to a recipient who has coverage from a third party payer not in contract with the clinic when aninsurer does reimburse the insured for the visit.4. Visits delivered by persons unqualified to deliver the services under state regulations.Transition - Visit Value and Data CollectionThe method of pricing uncompensated care visits and calculating uncompensated care volume will transition over time asfollows:Uncompensated Care Value:1. In 2010, OMH will base uncompensated care reimbursement on the appropriate peer group Medicaid rate for a 45minute psychotherapy procedure delivered by an LCSW.2. In 2011, the uncompensated care pool rate will be based on the peer group average value of mental health clinicMedicaid APG payments (no blend) for at least the first six months of 2010.3. In 2012 and after, payments will be based on the current peer group average value of total Medicaid APGpayments (no blend).Uncompensated Care Volume:1. Uncompensated care payments to Article 31 clinics during calendar year 2010 will be based on annualizeduncompensated care visit volume and total care visit volume delivered July 1, 2009 through December 31, 2009.2. Uncompensated care payments to Article 31 clinics during calendar year 2011 will be based on uncompensatedcare visit volume and total care visit volume for the period January 2010 through June 2010.3. Uncompensated care payments to Article 31 clinics during calendar year 2012 will be based on data as follows:a. Payments to clinics in NYC will be based on data from July 09 through June 2010.b. Payments to clinics in the rest of the state will be based on data from calendar year 2010.Uncompensated Care payments are awaiting final Federal approval of the NYS OMH 14 NYCRR Part 599 “ClinicTreatment Programs” regulations.Resources:1. NYS Clinic and Ambulatory Restructuring:https://www.omh.state.ny.us/omhweb/clinic_restructuring/indigent_care_overview.html